@A DiabetesTeam Member

The UK is a lot more progressive in their management of diabetes.

I suspect it is because of two main reasons - first, their national healthcare system covers most things including medication - so better control in the Type 2 population saves them money, particularly in the long run.

Second, until this covid mess spiked the Type 2 numbers worldwide, the UK had an incidence of about 12% while the rest of the western world was trending at 8% - so they had 50% "more" diabetics then say the US or Canada - it was a "bigger problem" that needed more drastic action.

The UK guidelines WILL protect against a number of complications if you simply push things to the MAX while the guidance for the rest of us "will not".

The "stay under 180/10 mmols" WILL Cause Heart Disease, Kidney Disease and increase the chances of Stroke - and surprise surprise - the number 1 and 2 killers of Type 2 are Heart Disease (60%) and Stroke (20%) with Kidney Disease close behind at 15% - that only leaves 5% of all other causes including Cancer and attack by Wild Dogs 😀

India of all places has even more stringent national guidelines - they aim to prevent "all complications" as their basic standard.

And that is what I just don't understand. What is the theory in setting a "guideline" that THEY KNOW will lead to the three leading causes of Death in Type 2's?

Is it to stop people from simply giving up completely when they can't reach a more stringent control number? Better to have "some control" then No Control at all??

I just wish they were transparent about it - we are all adults - tell the truth and let US decide if we are willing to roll the dice.

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A Diabete...

@A DiabetesTeam Member you made an excellent point there.

Because Type 2 is metabolic NONE of us fit the "average" and none of us are "typical".

The value I do see in the guidelines and guidance is that it can give each of us "somewhere to start".

The danger of the guidelines and guidance is that nobody tells us that they likely don't apply to us and they need to be "so personalized" to be of any value.

Even something as seemly straight forward as "eat less carbs" - well how much less?

The dietitian/nutritionist, who to give them credit is trying to protect "total health" and alleviate the need for supplemental vitamins/minerals tell us to eat about 200 carbs a day and medicate to manage.

Then the Endo studies come along and say no, eat under 150 and then revise that to under 130.

But "how much" under 130 - that's a "typical" number that their study produced.

If I ate 130 every day my A1C would go up - maybe a little but maybe I would get surprised.

To stay in my range about 110 carbs a day is it (on average).

@A DiabetesTeam Member and I discussed this last year or the year before. There was a good run there where we had very, very similar numbers - fasting and PPGs - like I mean it was insignificant the difference.

But Azure was eating a 20'ish carb a day Keto while I was following a High Fat at 110 a day.

To someone looking for "standard, average, typical" how can they begin to recon two people with identical numbers where one is eating over 5 times as many carbs as the other.

And the confusion would be understandable because "nobody" ever tells you, "there are no rules that apply specifically to you".

Sure we can tell you the basics - eat carbs your sugar will go up. By how much for a given number or type of carbs? We have NO IDEA but they will go up.

And most patients only want someone to tell them how to fix it. They have a low attention span, don't want to think about - give me a pill and tell me exactly what to eat and let me get on with my life.

That is what leads to "keep your blood sugar under 10/180, don't eat potato, rice, pasta or bread, try to eat more veggies, give up sugary drinks and get some exercise".

Zero value but most stopped listening anyhow when they heard "potato" and thought "how can I eat my Big Mac without Fries"? 😀

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A Diabete...

A Diabete...

Hey @A DiabetesTeam Member - absolutely and for a couple of reason (in your and my case).

Duration of diabetes causes the reduction of insulin production - we tend to burn things out "because of the diabetes".

Then couple that with aging which likewise "burns things out including pancreatic function" along with kidney function (which most of us are cognizant of, vision quality etc.

So as a "aging diabetic" we have that double whammy working to raise our blood sugar levels (through loss of pancreatic function and in increase in insulin resistance which would naturally occur whether or not we had diabetes).

But it's not all bad news because there is also good evidence now that after certain age milestones the need for stringent control to target levels from our younger years is not as important.

There is however a caveat to that statement - you must have kept decent control in your younger years.

If we can make it to our later 60's/early 70's relatively free of complications then we can "loosen" our control ranges and still "outlive the consequence of doing so".

The reason why so many will never get that benefit is because they blow themselves up far too much in their 40's and 50's - choosing to ignore the disease, or failing to believe that it is serious or whatever their reasons were.

That is why I am personally striving for control "today" and doing all the hard work "up front" - I have a plan that also includes "retiring some of my stringent control measures" if I can get to (my) target age and still have very good control.

I learned the game. I read the rules and screw the Beast, I'm going to play it to MY advantage.

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A Diabete...

I get a kick out of the powers that be to use the words generalized and typical. Graham is very correct to use these tems because that is how they word it to all of us. Diabetes though is not typical at all and generalized just paints us all with the same big brush. What we all have to learn is what is OUR diabetes which is unique to all of us. Similarities yes but that's where it stops. It's a fairly long road of trial and error to learn what keeps our diabetes in range....most of the time. It's like trying to hit a moving target so we have to take precise aim..All these numbers got confusing to me when I first started my journey. My dad was a chartered accountant... my mind doesn't work that way. There not really confusing though once I read through it all several times. There's only a few of them that pertain to my better health. I know what they are now and pay them strict attention. Now if only my hormones didn't play games with them it would make it much easier. Oh well,such is the life of the blood sugar impaired. We all know or should know what bg numbers could possibly produce complications and what those complications are.
I wish everyone the best of luck with their decision. 🙂

Last note on the above.

Those are generalized ranges based on a typical Adult Type 2 that is otherwise healthy.

Other health conditions can effect the range your doctor will set for you - trying to go for "tight control" in the presence of Heart Disease (as one example) can kill you, so range will be set to keep you alive as long as possible given other conditions.

Also, the older we are the less benefit there is in "tight control".

When I'm 80 (if I make it) I may not be too worried about a level of control to protect against a complication that could take 20 years to develop.

In broad terms, the younger you are when diagnosed the better control you should shoot for because you will have to live "with the Beast" for many DECADES.

PS - I kinda rounded some of the numbers above because there is some nuances.

I believe the ADA guidance at the low end is actually 70 mg/dl but you often see 72 in print because 4.0 mmols converts directly to 72 - so some post ranges that keep things "consistent".

And while the UK uses 8.5 as top of the range and the EU uses 8.7, 8.7 is actually the line that separates "damage to microvascular system" - so 8.7 is the scientific number, the 8.5 was probably more of a 8.0, 8.5 kinda thing (who knows).

In Canada the standard under 10.0 actually does drop to under 8.0 on an individual basis - once you achieve an A1C of under 6.0 the Doc is supposed to give you the "unpublished" range to keep you there - again, why not post it for all to see???